Dementia series: Advice on nutrition for people with dementia

GOOD nutrition is essential for health and wellbeing. Food and eating are an important part of our social lives. However, for people living with dementia, getting the correct nutrition through food can sometimes be difficult.

Dementia can lead to changes in appetite and sense of taste and smell, which can reduce the person’s desire to eat.

Some people with dementia have difficulties with sight and perception, and so can struggle with using cutlery. Some won’t recognise cutlery or remember its purpose, and will prefer to pick up food from a plate with their fingers. Rarely, a person may no longer recognise food as being food.

It is also the case that a person with dementia may lose their sense of time, and so forget to eat. Equally, they may have difficulty associating feelings of hunger with the need for food.

These are all things we take for granted but, for a person with dementia, they may be challenging.

Dementia can also result in difficulties in chewing and swallowing. Because of these difficulties, the person may need longer to eat each meal, and so may eat less, especially if the food has gone cold, or others have finished eating.

All these changes can have an impact on the amount and type of diet a person has, and hence they can become malnourished and may lose weight.

Similarly, some people with dementia have reduced thirst, and are prone to dehydration, especially during illness, or in warm weather.

However, occasionally, a person with dementia may eat more than usual, and gain weight. This can be due to a change in taste, such as preferring sugary food, or due to forgetting that they have recently eaten.

Tips for meal-times

If you are supporting a person with dementia, it can be upsetting to see them struggle with eating and drinking, and to see weight loss or weight gain. However, plenty can be done to help a person with dementia to continue to enjoy food and eating, and to maintain their nutrition.

Here are some things you can do to help thems:

Support the person in doing their shopping so that they have good availability of easy-to-prepare food at home

Remind the person when meals are due and try to maintain a routine

Consider meals-on-wheels, or a family member or home support carer calling at meal-times — ideally eating with the person

Make sure that glasses, dentures or hearing aids are worn during the meal if needed

Use specially-adapted utensils including cutlery, non-slip mats, high-sided plates or guards and two-handed or spouted cups – available from an occupational therapist

Avoid patterned table coverings and distracting items on the table that are not needed

Use contrasting coloured plates on a light background: red, yellow or blue are good

Serve food on small plates if a person has a small appetite or, if the person is slow to eat, serve a small portion first and then a second helping that you have kept warm

Consider foods that are easily eaten with the fingers if a person struggles with cutlery, such as fruit pieces, small sandwiches or cereal bars

When a person has difficulty eating or has reduced their food intake, you could think about the following suggestions:

Provide encouragement and assistance at meal-times

Encourage foods at times in the day you notice the person tends to eat better rather than only at traditional meal-times

Adopt a ‘little-and-often’ meal pattern

Try out alternatives to the foods the person traditionally ate, such as sweet or savoury options, as their taste may have changed

Serve favourite foods and make a list of current food preferences

Introduce nourishing snacks and drinks regularly throughout the day

Maximise the calories of the food eaten — adding milk or butter to mashed potato or grating cheese over a savoury dish

Don’t worry if the person you are caring for can’t manage a balanced diet every day. If they are not eating three meals a day, encourage snacks and finger foods. They can be very nourishing and can be easier to eat than larger meals.

First Port of Call

GPs and public health nurses are a good first port of call for useful advice on improving protein and calorie intake. Sometimes, they will refer the person with dementia to a dietitian for further assessment and advice.

The GP or the dietitian may recommend oral nutritional supplements — typically drinks or puddings with extra calories and protein.

If a person with dementia is coughing during or after meals or having choking episodes, it is important to let their GP know. They will usually send a referral to a speech and language therapist, who will assess the person’s swallowing, with food and drinks of different consistencies, and give detailed advice.

This series has been developed by Dementia: Understand Together, a public support, awareness and information campaign led by the HSE in partnership with The Alzheimer Society of Ireland and Genio. For more information, including details of dementia supports and services in Cork, visit understandtogether.ie or Freephone 1800 341 341